|
PR RESCJ PALATE/EXTENSIVE RESCJ LESION
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 42120
|
| Min. Negotiated Rate |
$820.80 |
| Max. Negotiated Rate |
$1,349.88 |
| Rate for Payer: Aetna Commercial |
$1,256.14
|
| Rate for Payer: Aetna Medicare |
$974.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,256.14
|
| Rate for Payer: BCBS Complete |
$820.80
|
| Rate for Payer: BCBS MAPPO |
$937.42
|
| Rate for Payer: BCN Medicare Advantage |
$937.42
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cofinity Commercial |
$1,349.88
|
| Rate for Payer: Cofinity Commercial |
$1,256.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$937.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$984.29
|
| Rate for Payer: Nomi Health Commercial |
$1,124.90
|
| Rate for Payer: PACE SWMI |
$937.42
|
| Rate for Payer: PHP Commercial |
$1,312.39
|
| Rate for Payer: PHP Medicare Advantage |
$937.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.80
|
| Rate for Payer: Priority Health Medicare |
$937.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$937.42
|
| Rate for Payer: UHC Medicare Advantage |
$937.42
|
| Rate for Payer: UMR Bronson Commercial |
$943.92
|
|
|
PR RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING
|
Professional
|
Both
|
$3,468.00
|
|
|
Service Code
|
HCPCS 58952
|
| Min. Negotiated Rate |
$1,387.20 |
| Max. Negotiated Rate |
$2,274.75 |
| Rate for Payer: Aetna Commercial |
$2,116.78
|
| Rate for Payer: Aetna Medicare |
$1,642.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,274.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,116.78
|
| Rate for Payer: BCBS Complete |
$1,387.20
|
| Rate for Payer: BCBS MAPPO |
$1,579.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,579.69
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Cofinity Commercial |
$2,274.75
|
| Rate for Payer: Cofinity Commercial |
$2,116.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,579.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,658.67
|
| Rate for Payer: Nomi Health Commercial |
$1,895.63
|
| Rate for Payer: PACE SWMI |
$1,579.69
|
| Rate for Payer: PHP Commercial |
$2,211.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,579.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,254.20
|
| Rate for Payer: Priority Health Medicare |
$1,579.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,579.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,579.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,595.28
|
|
|
PR RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD
|
Professional
|
Both
|
$4,936.00
|
|
|
Service Code
|
HCPCS 58951
|
| Min. Negotiated Rate |
$1,386.64 |
| Max. Negotiated Rate |
$3,208.40 |
| Rate for Payer: Aetna Commercial |
$1,858.10
|
| Rate for Payer: Aetna Medicare |
$1,442.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,996.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,858.10
|
| Rate for Payer: BCBS Complete |
$1,974.40
|
| Rate for Payer: BCBS MAPPO |
$1,386.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,386.64
|
| Rate for Payer: Cash Price |
$3,948.80
|
| Rate for Payer: Cash Price |
$3,948.80
|
| Rate for Payer: Cofinity Commercial |
$1,996.76
|
| Rate for Payer: Cofinity Commercial |
$1,858.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,386.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,455.97
|
| Rate for Payer: Nomi Health Commercial |
$1,663.97
|
| Rate for Payer: PACE SWMI |
$1,386.64
|
| Rate for Payer: PHP Commercial |
$1,941.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,386.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,208.40
|
| Rate for Payer: Priority Health Medicare |
$1,386.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,386.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,386.64
|
| Rate for Payer: UMR Bronson Commercial |
$2,270.56
|
|
|
PR RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
HCPCS 48105
|
| Min. Negotiated Rate |
$2,654.40 |
| Max. Negotiated Rate |
$4,313.40 |
| Rate for Payer: Aetna Commercial |
$3,660.48
|
| Rate for Payer: Aetna Medicare |
$2,840.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,933.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,660.48
|
| Rate for Payer: BCBS Complete |
$2,654.40
|
| Rate for Payer: BCBS MAPPO |
$2,731.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,731.70
|
| Rate for Payer: Cash Price |
$5,308.80
|
| Rate for Payer: Cash Price |
$5,308.80
|
| Rate for Payer: Cofinity Commercial |
$3,933.65
|
| Rate for Payer: Cofinity Commercial |
$3,660.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,731.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,868.28
|
| Rate for Payer: Nomi Health Commercial |
$3,278.04
|
| Rate for Payer: PACE SWMI |
$2,731.70
|
| Rate for Payer: PHP Commercial |
$3,824.38
|
| Rate for Payer: PHP Medicare Advantage |
$2,731.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.40
|
| Rate for Payer: Priority Health Medicare |
$2,731.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,731.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,731.70
|
| Rate for Payer: UMR Bronson Commercial |
$3,052.56
|
|
|
PR RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY
|
Professional
|
Both
|
$3,325.00
|
|
|
Service Code
|
HCPCS 58957
|
| Min. Negotiated Rate |
$1,330.00 |
| Max. Negotiated Rate |
$2,161.25 |
| Rate for Payer: Aetna Medicare |
$1,662.50
|
| Rate for Payer: BCBS Complete |
$1,330.00
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,161.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,529.50
|
|
|
PR RESEC RECURRENT LARYNX NERVE
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 31595
|
| Min. Negotiated Rate |
$550.80 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Aetna Medicare |
$688.50
|
| Rate for Payer: BCBS Complete |
$550.80
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: UMR Bronson Commercial |
$633.42
|
|
|
PR RESECTION CONDYLE DISTAL END PHALANX EACH TOE
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 28153
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$425.10 |
| Rate for Payer: Aetna Commercial |
$336.39
|
| Rate for Payer: Aetna Medicare |
$261.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.39
|
| Rate for Payer: BCBS Complete |
$261.60
|
| Rate for Payer: BCBS MAPPO |
$251.04
|
| Rate for Payer: BCN Medicare Advantage |
$251.04
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cofinity Commercial |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$336.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.59
|
| Rate for Payer: Nomi Health Commercial |
$301.25
|
| Rate for Payer: PACE SWMI |
$251.04
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicare Advantage |
$251.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.10
|
| Rate for Payer: Priority Health Medicare |
$251.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.04
|
| Rate for Payer: UHC Medicare Advantage |
$251.04
|
| Rate for Payer: UMR Bronson Commercial |
$300.84
|
|
|
PR RESECTION EXTERNAL CARDIAC TUMOR
|
Professional
|
Both
|
$4,644.00
|
|
|
Service Code
|
HCPCS 33130
|
| Min. Negotiated Rate |
$1,306.94 |
| Max. Negotiated Rate |
$3,018.60 |
| Rate for Payer: Aetna Commercial |
$1,751.30
|
| Rate for Payer: Aetna Medicare |
$1,359.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,881.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,751.30
|
| Rate for Payer: BCBS Complete |
$1,857.60
|
| Rate for Payer: BCBS MAPPO |
$1,306.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,306.94
|
| Rate for Payer: Cash Price |
$3,715.20
|
| Rate for Payer: Cash Price |
$3,715.20
|
| Rate for Payer: Cofinity Commercial |
$1,881.99
|
| Rate for Payer: Cofinity Commercial |
$1,751.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,306.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,372.29
|
| Rate for Payer: Nomi Health Commercial |
$1,568.33
|
| Rate for Payer: PACE SWMI |
$1,306.94
|
| Rate for Payer: PHP Commercial |
$1,829.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,306.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.60
|
| Rate for Payer: Priority Health Medicare |
$1,306.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,306.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,306.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,136.24
|
|
|
PR RESECTION HUMERAL HEAD
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 23195
|
| Min. Negotiated Rate |
$658.00 |
| Max. Negotiated Rate |
$1,069.25 |
| Rate for Payer: Aetna Commercial |
$969.87
|
| Rate for Payer: Aetna Medicare |
$752.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.24
|
| Rate for Payer: BCBS Complete |
$658.00
|
| Rate for Payer: BCBS MAPPO |
$723.78
|
| Rate for Payer: BCN Medicare Advantage |
$723.78
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$969.87
|
| Rate for Payer: Cofinity Commercial |
$1,042.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$723.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.97
|
| Rate for Payer: Nomi Health Commercial |
$868.54
|
| Rate for Payer: PACE SWMI |
$723.78
|
| Rate for Payer: PHP Commercial |
$1,013.29
|
| Rate for Payer: PHP Medicare Advantage |
$723.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.25
|
| Rate for Payer: Priority Health Medicare |
$723.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$723.78
|
| Rate for Payer: UHC Medicare Advantage |
$723.78
|
| Rate for Payer: UMR Bronson Commercial |
$756.70
|
|
|
PR RESECTION/INCISION SUBVALVULAR TISSUE
|
Professional
|
Both
|
$6,220.00
|
|
|
Service Code
|
HCPCS 33415
|
| Min. Negotiated Rate |
$1,944.37 |
| Max. Negotiated Rate |
$4,043.00 |
| Rate for Payer: Aetna Commercial |
$2,605.46
|
| Rate for Payer: Aetna Medicare |
$2,022.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,799.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,605.46
|
| Rate for Payer: BCBS Complete |
$2,488.00
|
| Rate for Payer: BCBS MAPPO |
$1,944.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,944.37
|
| Rate for Payer: Cash Price |
$4,976.00
|
| Rate for Payer: Cash Price |
$4,976.00
|
| Rate for Payer: Cofinity Commercial |
$2,799.89
|
| Rate for Payer: Cofinity Commercial |
$2,605.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,944.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,041.59
|
| Rate for Payer: Nomi Health Commercial |
$2,333.24
|
| Rate for Payer: PACE SWMI |
$1,944.37
|
| Rate for Payer: PHP Commercial |
$2,722.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,944.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,043.00
|
| Rate for Payer: Priority Health Medicare |
$1,944.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,944.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,944.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,861.20
|
|
|
PR RESECTION MEDIASTINAL TUMOR
|
Professional
|
Both
|
$5,782.00
|
|
|
Service Code
|
HCPCS 39220
|
| Min. Negotiated Rate |
$1,094.00 |
| Max. Negotiated Rate |
$3,758.30 |
| Rate for Payer: Aetna Commercial |
$1,465.96
|
| Rate for Payer: Aetna Medicare |
$1,137.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,575.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.96
|
| Rate for Payer: BCBS Complete |
$2,312.80
|
| Rate for Payer: BCBS MAPPO |
$1,094.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,094.00
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Cofinity Commercial |
$1,575.36
|
| Rate for Payer: Cofinity Commercial |
$1,465.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,094.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,148.70
|
| Rate for Payer: Nomi Health Commercial |
$1,312.80
|
| Rate for Payer: PACE SWMI |
$1,094.00
|
| Rate for Payer: PHP Commercial |
$1,531.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,094.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,758.30
|
| Rate for Payer: Priority Health Medicare |
$1,094.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,094.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,659.72
|
|
|
PR RESECTION OF MEDIASTINAL CYST
|
Professional
|
Both
|
$5,041.00
|
|
|
Service Code
|
HCPCS 39200
|
| Min. Negotiated Rate |
$837.84 |
| Max. Negotiated Rate |
$3,276.65 |
| Rate for Payer: Aetna Commercial |
$1,122.71
|
| Rate for Payer: Aetna Medicare |
$871.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,122.71
|
| Rate for Payer: BCBS Complete |
$2,016.40
|
| Rate for Payer: BCBS MAPPO |
$837.84
|
| Rate for Payer: BCN Medicare Advantage |
$837.84
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cofinity Commercial |
$1,206.49
|
| Rate for Payer: Cofinity Commercial |
$1,122.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$837.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$879.73
|
| Rate for Payer: Nomi Health Commercial |
$1,005.41
|
| Rate for Payer: PACE SWMI |
$837.84
|
| Rate for Payer: PHP Commercial |
$1,172.98
|
| Rate for Payer: PHP Medicare Advantage |
$837.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,276.65
|
| Rate for Payer: Priority Health Medicare |
$837.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$837.84
|
| Rate for Payer: UHC Medicare Advantage |
$837.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,318.86
|
|
|
PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 28126
|
| Min. Negotiated Rate |
$238.62 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Commercial |
$319.75
|
| Rate for Payer: Aetna Medicare |
$248.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.75
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS MAPPO |
$238.62
|
| Rate for Payer: BCN Medicare Advantage |
$238.62
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$343.61
|
| Rate for Payer: Cofinity Commercial |
$319.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.55
|
| Rate for Payer: Nomi Health Commercial |
$286.34
|
| Rate for Payer: PACE SWMI |
$238.62
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicare Advantage |
$238.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health Medicare |
$238.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.62
|
| Rate for Payer: UHC Medicare Advantage |
$238.62
|
| Rate for Payer: UMR Bronson Commercial |
$318.78
|
|
|
PR RESECTION PERICARDIAL CYST/TUMOR
|
Professional
|
Both
|
$2,869.00
|
|
|
Service Code
|
HCPCS 33050
|
| Min. Negotiated Rate |
$968.05 |
| Max. Negotiated Rate |
$1,864.85 |
| Rate for Payer: Aetna Commercial |
$1,297.19
|
| Rate for Payer: Aetna Medicare |
$1,006.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,393.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.19
|
| Rate for Payer: BCBS Complete |
$1,147.60
|
| Rate for Payer: BCBS MAPPO |
$968.05
|
| Rate for Payer: BCN Medicare Advantage |
$968.05
|
| Rate for Payer: Cash Price |
$2,295.20
|
| Rate for Payer: Cash Price |
$2,295.20
|
| Rate for Payer: Cofinity Commercial |
$1,393.99
|
| Rate for Payer: Cofinity Commercial |
$1,297.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.45
|
| Rate for Payer: Nomi Health Commercial |
$1,161.66
|
| Rate for Payer: PACE SWMI |
$968.05
|
| Rate for Payer: PHP Commercial |
$1,355.27
|
| Rate for Payer: PHP Medicare Advantage |
$968.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,864.85
|
| Rate for Payer: Priority Health Medicare |
$968.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.05
|
| Rate for Payer: UHC Medicare Advantage |
$968.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,319.74
|
|
|
PR RESECTION RIBS EXTRAPLEURAL ALL STAGES
|
Professional
|
Both
|
$3,144.00
|
|
|
Service Code
|
HCPCS 32900
|
| Min. Negotiated Rate |
$1,257.60 |
| Max. Negotiated Rate |
$2,043.60 |
| Rate for Payer: Aetna Commercial |
$1,878.52
|
| Rate for Payer: Aetna Medicare |
$1,457.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,878.52
|
| Rate for Payer: BCBS Complete |
$1,257.60
|
| Rate for Payer: BCBS MAPPO |
$1,401.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,401.88
|
| Rate for Payer: Cash Price |
$2,515.20
|
| Rate for Payer: Cash Price |
$2,515.20
|
| Rate for Payer: Cofinity Commercial |
$2,018.71
|
| Rate for Payer: Cofinity Commercial |
$1,878.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,401.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,471.97
|
| Rate for Payer: Nomi Health Commercial |
$1,682.26
|
| Rate for Payer: PACE SWMI |
$1,401.88
|
| Rate for Payer: PHP Commercial |
$1,962.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,401.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,043.60
|
| Rate for Payer: Priority Health Medicare |
$1,401.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,401.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,401.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,446.24
|
|
|
PR RESECTION SCROTUM
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 55150
|
| Min. Negotiated Rate |
$472.41 |
| Max. Negotiated Rate |
$1,030.90 |
| Rate for Payer: Aetna Commercial |
$633.03
|
| Rate for Payer: Aetna Medicare |
$491.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$680.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.03
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$472.41
|
| Rate for Payer: BCN Medicare Advantage |
$472.41
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$680.27
|
| Rate for Payer: Cofinity Commercial |
$633.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.03
|
| Rate for Payer: Nomi Health Commercial |
$566.89
|
| Rate for Payer: PACE SWMI |
$472.41
|
| Rate for Payer: PHP Commercial |
$661.37
|
| Rate for Payer: PHP Medicare Advantage |
$472.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$472.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.41
|
| Rate for Payer: UHC Medicare Advantage |
$472.41
|
| Rate for Payer: UMR Bronson Commercial |
$729.56
|
|
|
PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 23440
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,052.55 |
| Rate for Payer: Aetna Commercial |
$979.46
|
| Rate for Payer: Aetna Medicare |
$760.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,052.55
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS MAPPO |
$730.94
|
| Rate for Payer: BCN Medicare Advantage |
$730.94
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$979.46
|
| Rate for Payer: Cofinity Commercial |
$1,052.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$730.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$767.49
|
| Rate for Payer: Nomi Health Commercial |
$877.13
|
| Rate for Payer: PACE SWMI |
$730.94
|
| Rate for Payer: PHP Commercial |
$1,023.32
|
| Rate for Payer: PHP Medicare Advantage |
$730.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health Medicare |
$730.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$730.94
|
| Rate for Payer: UHC Medicare Advantage |
$730.94
|
| Rate for Payer: UMR Bronson Commercial |
$622.38
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94375
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$47.62
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.62
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$35.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.54
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$47.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.32
|
| Rate for Payer: Nomi Health Commercial |
$42.65
|
| Rate for Payer: PACE SWMI |
$35.54
|
| Rate for Payer: PHP Commercial |
$49.76
|
| Rate for Payer: PHP Medicare Advantage |
$35.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$35.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.54
|
| Rate for Payer: UHC Medicare Advantage |
$35.54
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
PR RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 90378
|
| Min. Negotiated Rate |
$1,476.00 |
| Max. Negotiated Rate |
$2,398.50 |
| Rate for Payer: Aetna Medicare |
$1,845.00
|
| Rate for Payer: BCBS Complete |
$1,476.00
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,398.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,697.40
|
|
|
PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 37222
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Aetna Commercial |
$237.72
|
| Rate for Payer: Aetna Medicare |
$184.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.46
|
| Rate for Payer: BCBS Complete |
$238.40
|
| Rate for Payer: BCBS MAPPO |
$177.40
|
| Rate for Payer: BCN Medicare Advantage |
$177.40
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$237.72
|
| Rate for Payer: Cofinity Commercial |
$255.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.27
|
| Rate for Payer: Nomi Health Commercial |
$212.88
|
| Rate for Payer: PACE SWMI |
$177.40
|
| Rate for Payer: PHP Commercial |
$248.36
|
| Rate for Payer: PHP Medicare Advantage |
$177.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health Medicare |
$177.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.40
|
| Rate for Payer: UHC Medicare Advantage |
$177.40
|
| Rate for Payer: UMR Bronson Commercial |
$274.16
|
|
|
PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37220
|
| Min. Negotiated Rate |
$381.29 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$510.93
|
| Rate for Payer: Aetna Medicare |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.93
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$381.29
|
| Rate for Payer: BCN Medicare Advantage |
$381.29
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$549.06
|
| Rate for Payer: Cofinity Commercial |
$510.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.35
|
| Rate for Payer: Nomi Health Commercial |
$457.55
|
| Rate for Payer: PACE SWMI |
$381.29
|
| Rate for Payer: PHP Commercial |
$533.81
|
| Rate for Payer: PHP Medicare Advantage |
$381.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$381.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$381.29
|
| Rate for Payer: UHC Medicare Advantage |
$381.29
|
| Rate for Payer: UMR Bronson Commercial |
$445.74
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT
|
Professional
|
Both
|
$4,999.00
|
|
|
Service Code
|
HCPCS 24371
|
| Min. Negotiated Rate |
$1,698.92 |
| Max. Negotiated Rate |
$3,249.35 |
| Rate for Payer: Aetna Commercial |
$2,276.55
|
| Rate for Payer: Aetna Medicare |
$1,766.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,276.55
|
| Rate for Payer: BCBS Complete |
$1,999.60
|
| Rate for Payer: BCBS MAPPO |
$1,698.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,698.92
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Cofinity Commercial |
$2,446.44
|
| Rate for Payer: Cofinity Commercial |
$2,276.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,698.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,783.87
|
| Rate for Payer: Nomi Health Commercial |
$2,038.70
|
| Rate for Payer: PACE SWMI |
$1,698.92
|
| Rate for Payer: PHP Commercial |
$2,378.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,698.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,249.35
|
| Rate for Payer: Priority Health Medicare |
$1,698.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,698.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,698.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,299.54
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT
|
Professional
|
Both
|
$3,780.00
|
|
|
Service Code
|
HCPCS 24370
|
| Min. Negotiated Rate |
$1,479.30 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna Commercial |
$1,982.26
|
| Rate for Payer: Aetna Medicare |
$1,538.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,982.26
|
| Rate for Payer: BCBS Complete |
$1,512.00
|
| Rate for Payer: BCBS MAPPO |
$1,479.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,479.30
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cofinity Commercial |
$2,130.19
|
| Rate for Payer: Cofinity Commercial |
$1,982.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,479.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,553.27
|
| Rate for Payer: Nomi Health Commercial |
$1,775.16
|
| Rate for Payer: PACE SWMI |
$1,479.30
|
| Rate for Payer: PHP Commercial |
$2,071.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,479.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,457.00
|
| Rate for Payer: Priority Health Medicare |
$1,479.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,479.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,479.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,738.80
|
|
|
PR REVISION OF LARYNX, UNSPECIFIED
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 31588
|
| Min. Negotiated Rate |
$824.00 |
| Max. Negotiated Rate |
$1,339.00 |
| Rate for Payer: Aetna Medicare |
$1,030.00
|
| Rate for Payer: BCBS Complete |
$824.00
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.00
|
| Rate for Payer: UMR Bronson Commercial |
$947.60
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$535.92 |
| Max. Negotiated Rate |
$1,096.20 |
| Rate for Payer: Aetna American Axle |
$791.70
|
| Rate for Payer: Aetna Commercial |
$1,035.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.70
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,047.48
|
| Rate for Payer: Cofinity Commercial |
$852.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$852.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Healthscope Commercial |
$1,096.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$852.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$913.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: PHP Commercial |
$1,035.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health SBD |
$767.34
|
| Rate for Payer: UMR Bronson Commercial |
$535.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$913.50
|
|
